Navegando por Palavras-chave "Randomized controlled trials"
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- ItemAcesso aberto (Open Access)Avaliação da qualidade de estudos clínicos e seu impacto nas metanálises(Faculdade de Saúde Pública da Universidade de São Paulo, 2005-12-01) Silva Filho, Carlos Rodrigues da [UNIFESP]; Saconato, Humberto; Conterno, Lucieni de Oliveira [UNIFESP]; Marques, Iara; Atallah, Álvaro Nagib [UNIFESP]; Faculdade Estadual de Medicina de Marília; Universidade Federal do Rio Grande do Norte; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To evaluate whether different quality assessment tools applied to a group of clinical trials could be correlated, and what would be their impact on meta-analysis results. METHODS: Thirty-eight randomized controlled clinical trials were analyzed. These had been selected for a systematic review of the therapeutic efficacy of alpha interferon for treating chronic hepatitis B. The following tools were utilized: Maastricht (M), Delphi (D), Jadad (J) and the Cochrane Collaboration (CC) method (gold standard). The Spearman correlation coefficient was used to compare the results from the three methods. The Kappa test was used to assess the concordance between the reviewers in applying the tools, and the weighted Kappa test was applied to compare the quality ranking determined by the tools. The outcomes assessed in the meta-analyses were clearance of HBV-DNA and HBeAg. RESULTS: The studies presented regular to low quality. The concordance between reviewers varied according to the instrument utilized: D=0.12; J=0.29; M=0.33; and CC=0.53. The correlation was moderate and homogeneous (D/J=0.51; D/M=0.53; and J/M=0.52). Thje meta-analysis result relating to HBV-DNA ranged from RR=0.71 (95% CI: 0.66-0.77) to RR=0.67 (95% CI: 0.58-0.79). For HBeAg, the results ranged from RR=0.85 (95% CI: 0.80-0.90) to RR=0.85 ( 95% CI: 0.77-0.93). These results depended on the quality of the studies included. CONCLUSIONS: The quality assessment tools presented good correlation. In systematic reviews with the same direction of effect, the quality assessment may not significantly change the results. The Cochrane Collaboration method was the most reproducible method and easiest to apply.
- ItemSomente MetadadadosThe effect of participation in school-based nutrition education interventions on body mass index: A meta-analysis of randomized controlled community trials(Elsevier B.V., 2013-03-01) Cardoso da Silveira, Jonas Augusto [UNIFESP]; Aguiar Carrazedo Taddei, Jose Augusto de [UNIFESP]; Guerra, Paulo Henrique; Cuce Nobre, Moacyr Roberto; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)Objective. the aim of this study was to evaluate the effectiveness of school-based nutrition education interventions in reducing or preventing overweight and obesity among children and adolescents.Methods. We conducted a systematic search of 14 databases until May 2010 and cross-reference check in 8 systematic reviews (SRs) for studies published that described randomized controlled trials conducted in schools to reduce or prevent overweight in children and adolescents. An additional search was carried out using PubMed for papers published through May 2012, and no further papers were identified. Body mass index (BMI) was the primary outcome. the title and abstract review and the quality assessment were performed independently by two researchers. the software EPPI-Reviewer3 was used to store, manage and analyze all data. This SR is registered at ClinicalTrials.gov (NCT00985972).Results. From the 4888 references initially retrieved, only 8 met the eligibility criteria for a random-effects meta-analysis. the total population consisted of 8722 children and adolescents. Across the studies, there was an average treatment effect of -0.33 kg/m(2) (-0.55, 0.11 95% CI) on BMI, with 84% of this effect explained by the highest quality studies.Conclusion. This systematic review provides evidence that school-based nutrition education interventions are effective in reducing the BMI of children and adolescents. (c) 2013 Elsevier Inc. All rights reserved.
- ItemAcesso aberto (Open Access)Psiquiatria baseada em evidências(Associação Brasileira de Psiquiatria - ABP, 2000-09-01) Lima, Mauricio Silva de [UNIFESP]; Soares, Bernardo Go; Bacaltchuk, Josué [UNIFESP]; Universidade Federal de Pelotas Departamento de Saúde Mental; Universidade Federal de Pelotas; Universidade Federal de São Paulo (UNIFESP)The unnecessary variability often seen in the clinical practice can be related to both the absence of reliable evidence and unawareness of the existence of good quality evidence. Evidence-Based Medicine (EBM) is a set of linked strategies designed to assist clinicians in keeping themselves up-to-date with the best available evidence. Such evidence must be incorporated into the clinical practice. EBM concepts are discussed here through common aspects and challenges doctors face when treating patients with dysthymia, bulimia nervosa, and schizophrenia. In the light of some results from three systematic reviews it is concluded that Evidence-Based Psychiatry strategies, rather than replacing the traditional ones, may be a valuable tool to improving quality in a good clinical practice.
- ItemAcesso aberto (Open Access)Rubber band ligation and infrared photocoagulation for the outpatient treatment of hemorrhoidal disease(Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2008-02-01) Ricci, Maurício Pichler [UNIFESP]; Matos, Delcio [UNIFESP]; Saad, Sarhan Sydney [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To compare the results of rubber band ligation and infrared photocoagulation for the treatment of hemorrhoidal disease through the analysis of the incidence of complications after each treatment and respective success rate. METHODS: Forty-eight patients with first, second or third degree hemorrhoidal disease were randomized to recieve treatment with either rubber band ligation (n=23) or infrared photocoagulation (n=25). Each patient was assessed at 1 week and 4 week intervals after treatment. We compared the incidence of complications and efficiency of each treatment modality and Qui-square, Fisher's Exact Test and Student's t Test were used to statistical analysis. RESULTS: Bleeding occured in eigth (34,7%) patients treated with rubber band ligation and in four (16,0%) after infrared photocoagulation (p=0,243). Thirteen (52,0%) patients felt pain during infrared photocoagulation and 9 (39,1%) after rubber band ligation (p=0,546). After rubber band ligation, 14 (60,8%) required medication for pain relief. One patient (4,0%) required medication after infrared photocoagulation (p<0,001). Three (13,0%) patients treated with rubber band ligator and 1 (4,0%) treated with infrared photocoagulation had symptomatic mucosal ulcers. Perianal dermatitis occured in two (8,0%) patients treated with infrared photocoagulation and one patient (4,3%) was observed to have prolapsed thrombosed piles after rubber band ligation. One month after treatment, 17 of 23 patients treated with rubber band ligation (73,9%) and 18 of 25 patients treated with infrared photocoagulation were asymptomatic. Rubber band ligation treated bleeding and prolapse in 90,0% and 82,4% respectively. Infrared photocoagulation treates bleeding and prolapse in 93,7% and 87,5% respectively. Those differences are not significant. CONCLUSION: Rubber band ligation causes significantly more pain than infrared photocoagulation during the first week after the procedures and their success rate are not different after four weeks of treatment.
- ItemSomente MetadadadosSurgical Treatments for Chronic Subdural Hematomas: A Comprehensive Systematic Review(Elsevier Science Inc, 2016) Ivamoto, Henrique Seiji [UNIFESP]; Lemos Jr., Hernani Pinto [UNIFESP]; Atallah, Alvaro Nagib [UNIFESP]BACKGROUND: Chronic subdural hematomas (CSDHs) are common neurosurgical conditions among elderly patients. OBJECTIVE: To perform a detailed critical appraisal of all randomized controlled trials (RCTs) of surgical treatments for chronic subdural hematomas and to quantify their intervention effects. - METHODS: We performed a broad search for all RCTs with no language or date restrictions, asked the authors for missing data, and applied the Cochrane methods. RESULTS: A total of 24 RCTs involved 1900 patients and 15 comparisons. All outcomes of practical interest were analyzed. Postoperative drainage after burrhole evacuation reduced the rate of recurrence (risk ratio 0.48, 95% confidence interval 0.34-0.66, P < 0.00001) with no other clear benefits or complications. CONCLUSIONS: This comprehensive, best evidence-based, quantitative, systematic review indicates that the use of a closed system drainage after burrhole evacuation reduces the rate of recurrences but has no other significant differences. The findings also suggest that: (1) treatment with twist drills is equivalent to that with burr holes; (2) the postoperative bed header in the elevated position might reduce the length of hospital stay; (3) irrigation of the subdural space with thrombin solution in patients with high risk of recurrence might reduce this risk; and (4) treatment with twist drill followed by a closed system drainage during 48 hours, instead of 96 hours, might reduce general complication rates. Most of the trials suffered from unclear or high risks of bias and many involved small samples, precluding strong and definitive conclusions.
- ItemAcesso aberto (Open Access)Surgical Treatments for Chronic Subdural Hematomas: A Comprehensive Systematic Review(Elsevier Science Inc, 2016) Ivamoto, Henrique Seiji [UNIFESP]; Lemos Jr., Hernani Pinto [UNIFESP]; Atallah, Alvaro Nagib [UNIFESP]BACKGROUND: Chronic subdural hematomas (CSDHs) are common neurosurgical conditions among elderly patients. OBJECTIVE: To perform a detailed critical appraisal of all randomized controlled trials (RCTs) of surgical treatments for chronic subdural hematomas and to quantify their intervention effects. - METHODS: We performed a broad search for all RCTs with no language or date restrictions, asked the authors for missing data, and applied the Cochrane methods. RESULTS: A total of 24 RCTs involved 1900 patients and 15 comparisons. All outcomes of practical interest were analyzed. Postoperative drainage after burrhole evacuation reduced the rate of recurrence (risk ratio 0.48, 95% confidence interval 0.34-0.66, P < 0.00001) with no other clear benefits or complications. CONCLUSIONS: This comprehensive, best evidence-based, quantitative, systematic review indicates that the use of a closed system drainage after burrhole evacuation reduces the rate of recurrences but has no other significant differences. The findings also suggest that: (1) treatment with twist drills is equivalent to that with burr holes; (2) the postoperative bed header in the elevated position might reduce the length of hospital stay; (3) irrigation of the subdural space with thrombin solution in patients with high risk of recurrence might reduce this risk; and (4) treatment with twist drill followed by a closed system drainage during 48 hours, instead of 96 hours, might reduce general complication rates. Most of the trials suffered from unclear or high risks of bias and many involved small samples, precluding strong and definitive conclusions.